Background: School nurses intervene with students, families, and school staff to maintain or improve the health and academic success of students. To display school nurse impact on student health and success, their work must be identified and measured. Although some data on school nursing services exist, datasets are disparate, not standardized. Examining the impact of school nurses on student health and education outcomes is necessary to illustrate the need for students to have access to a school nurse each day.

Purpose: This is a three-manuscript dissertation. Chapter 2 presents an integrative review of the literature that explores school nurse interventions, activities, and student health and education outcomes. Chapter 3 presents the results that describe trends in data for North Carolina public schools of school nurse health services and programs, utilized by grade level. Chapter 4 examines the impact of school nurse-to-student ratios, and health services and programs on student outcomes.

Methods: Chapter 2 is an integrative review that uses the Framework for 21st Century School Nursing Practice to explore school nurse interventions and activities, and student outcome measures. Chapter 3 presents results of longitudinal repeated measures study that used generalized linear modeling and Poisson regression to test the effect of time and grade on trends of school nurse health services and programs in North Carolina public schools, stratified by grade level. Chapter 4 used generalized linear modeling with a gamma distribution to estimate the association between school nurse-to-student ratios and health services and programs on the outcomes of students with asthma and diabetes.

Results: Over time, more students were identified with various health conditions, and had more orders for health care procedures to be conducted in the school setting. Also, lower school nurse-to-student ratios were associated with some improved student health and education outcomes in students with asthma and diabetes.

Conclusions: School nurses do have an impact on student outcomes. There is an identified need to find determine the impact of school nurse interventions on school nurse sensitive indicator.